Abstract
Background Worldwide, over 740 million women make their living in the informal economy. These women do not benefit from formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding but little is known about how informal work impacts on infant feeding.Methods The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in the informal sector in India and South Africa. Data was analysed using a thematic approach and the framework method.Findings Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations often forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about breastmilk becoming ‘spoilt’. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding and childcare. Mothers also described being unable to complete their work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of child care and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as good for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected the ability of working mothers to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.Conclusion Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support optimal feeding and child care if global nutrition and development goals are to be met.
Child-Care Choices by Working Mothers: The Case of Italy